Lecture b Introduction to Quality Improvement and Health Information Technology

1. Quality Improvement
Introduction to Quality Improvement
and Health Information Technology
Lecture b
This material (Comp 12 Unit 1) was developed by Johns Hopkins University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000013. This material was updated in 2016 by Johns Hopkins University under Award
Number 90WT0005.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

2. Introduction to Quality Improvement
and Health Information Technology
Objectives — Lecture b
• Explain health care quality and quality
improvement (QI).
• Describe quality improvement as a goal of
key national health care priorities,
including the National Quality Strategy.
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3. Quality Health Care
“Quality of care is the degree to which health
services for individuals and populations
increase the likelihood of desired outcomes
and are consistent with current professional
knowledge.” (IOM, 2001)
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4. Quality Health Care — Who
Defines it?
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5. Organizations That Are Part of the
Tapestry of QI and Health Care
• National Quality Forum (NQF)
• National Committee for Quality Assurance
(NCQA)
• Provider organizations:
– AMA’s Physician Consortium for Performance
Improvement (PCPI)
• Joint Commission (JC)
• Institute for Healthcare Improvement (IHI)
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6. U.S. Health Care System:
How Are We Doing?
• Needs to be improved, especially for the
uninsured.
• Patient safety and health care–associated
infections have shown improvement.
• Quality is improving, but pace is slow,
especially in preventive care & chronic
disease management.
• Disparities are common, and lack of
insurance is a contributor.
• Many disparities are not decreasing;
those that warrant increased attention
include care for cancer, heart failure, and
pneumonia.
Source: AHRQ Research Findings page.
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7. National Quality Strategy (NQS)
Aims
• Better care: improve overall quality by making health
care more patient centered, reliable, accessible, and
safe.
• Healthy people/healthy communities: improve the
health of the U.S. population by supporting proven
interventions to address behavioral, social, and
environmental determinants of health in addition to
delivering higher quality care.
• Affordable care: reduce the cost of quality health
care for individuals, families, employers, and
government.
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8. National Quality Strategy (NQS)
Priorities
• Patient safety: making care safer by reducing harm caused in the
delivery of care.
• Person-centered care: ensuring that each person and family is
engaged as partners in their care.
• Care coordination: promoting effective communication and
coordination of care.
• Effective treatment: promoting the most effective prevention and
treatment practices for the leading causes of mortality, starting with
cardiovascular disease.
• Healthy living: working with communities to promote wide use of
best practices to enable healthy living.
• Care affordability: making quality care more affordable for
individuals, families, employers, and governments by developing
and spreading new health care delivery models.
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9. Basics of Quality Improvement
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10. Set an Aim
• Make it specific.
– Assign it a number if possible.
• Assign it a timeline.
• Make it measurable.
• Make sure it is challenging but doable.
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11. Measure
• Process Measure: Are we
doing what we must to get the
improvement we seek?
• Outcome Measure: Are we
getting what we expect?
• Balancing Measure: Are we
causing new problems in other
parts of the system?
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12. Examples
Hospital
• Aim: we will reduce the number of
ventilator-associated pneumonias
(VAP) in the ICU from the current
23% to under 10% in 4 months.
• Measures:
– Process measure:
o Ventilator days
o Over-sedation hours
o Oral care performed
– Outcome measure: Number of
VAP
– Balancing measure:
o Cost of care
o Re-intubation rates
Ambulatory
• Aim: we will reduce the amount of
time it takes our patients to get an
appointment (request to
appointment) from 23 days to 0
days in 6 months.
• Measures:
– Process measure:
o Supply
o Demand
o No-show rate
– Outcome measure: Third next
available appointment
– Balancing measure: Patient
satisfaction
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13. Change
• Concepts and strategies: decide on the overall changes
that will lead to the desired improvement.
• Specific changes:
– Make them small.
– Make them fast.
– Make them frequent.
• You may need to include additional measures
specifically to decide if a change you have tested is
worth keeping or did not lead to improvement.
• Consider using pre-existing change packages.
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14. Example of a Change Package
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15. Learn
• One of the most important aspects of QI is to
understand how your systems actually perform,
under a range of conditions.
• Deming’s theory of profound knowledge is based on
the principle that each organization is composed of
a system of interrelated processes and people.
• The improvement of the system depends on the
capability to organize the balance of each
component to enhance the entire system.
• Understanding and learning about your system is
essential to improve it.
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16. Introduction to Quality Improvement
and Health Information Technology
Summary — Lecture b
• The quality of care received in the U.S.
needs improvement.
• Quality improvement is an ongoing
process that includes the setting of an aim
and a progressive measurement, change
test, and understanding of the system.
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17. Introduction to Quality Improvement
and Health Information Technology
References — Lecture b — 1
References
Agency for Healthcare Research and Quality (AHRQ). Available from:
http://www.ahrq.gov/
Agency for Healthcare Research and Quality. (2013). National Healthcare Quality Report.
2013. Retrieved March 28, 2016, from
http://www.ahrq.gov/research/findings/nhqrdr/nhqr13/index.html
Centers for Medicare and Medicaid Services. Available from: http://www.cms.gov/
IOM — Institute of Medicine. Available from: http://www.nationalacademies.org/hmd/
Institute for Healthcare Improvement (IHI) Available from:
http://www.ihi.org/Pages/default.aspx
Joint Commission. Available from: http://www.jointcommission.org/
National Committee for Quality Assurance. Available from: http://www.ncqa.org/
National Quality Forum (NQF). Available from: http://www.qualityforum.org/Home.aspx
Physician Consortium for Performance Improvement (PCPI) – American Medial
Association. Available from: https://www.thepcpi.org/
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18. Introduction to Quality Improvement
and Health Information Technology
References — Lecture b — 2
Charts, Tables, Figures
1.2 Table: Example of a Change Care Package. California Academy of Family Physicians
Diabetes Initiative Care Model Change Package. Available from:
http://eo2.commpartners.com/users/acme/downloads/CAFP._Diabetes_Change_Pac
kage.pdf
Images
Slide 4: Quality Health Care: Who Defines It? Courtesy of Dr. Anna Maria Izquierdo-
Porrera.
Slide 6: Cover of the 2013 National Healthcare Quality Report and the 2014 National
Healthcare Quality and Disparities Report. Agency for Healthcare Research and
Quality. Retrieved March 28, 2016, from:
http://www.ahrq.gov/research/findings/nhqrdr/index.html
Slide 9: Basics of Quality Improvement. Courtesy of Dr. Anna Maria Izquierdo-Porrera.
Slide 11: Process Measure, Outcome Measure, Balancing Measure. Courtesy of Dr. Anna
Maria Izquierdo-Porrera.
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19. Quality Improvement
Introduction to Quality Improvement
and Health Information Technology
Lecture b
This material (Comp 12 Unit 1) was developed by
Johns Hopkins University, funded by the
Department of Health and Human Services, Office
of the National Coordinator for Health Information
Technology under Award Number IU24OC000013.
This material was updated in 2016 by Johns
Hopkins University under Award Number
90WT0005.
19